- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for Medicare risk adjustment related estimates, establishing premium rates, financial analysis, and ... scores, and analyze impact. **KNOWLEDGE/SKILLS/ABILITIES** + Collaborate with Actuarial staff to calculate risk adjustment...+ Collaborate with Actuarial staff to calculate risk adjustment payment estimates. Document assumptions. +… more
- Humana (Tallahassee, FL)
- …Medical Claims or other healthcare data + Medicare Risk Adjustment Experience + Financial or actuarial background + Masters Degree **Additional ... factors. This position utilizes financial projection and analytics skills while working in Medicare risk adjustment . Additionally, you will work to build… more
- Molina Healthcare (St. Petersburg, FL)
- …Analytics role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Molina Healthcare (Jacksonville, FL)
- …+ Extensive understanding of Medicare Advantage, ACA and Medicaid risk adjustment processes, including encounter data submission and deletion requirements ... **Job Description** **Job Summary** The AVP, Risk Adjustment Encounters is responsible for...processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This… more
- Humana (Tallahassee, FL)
- …Market Finance Professional works closely with corporate finance, provider engagement, clinical, risk adjustment and quality teams to ensure providers are ... Analyze provider performance under value-based contracts, including cost, utilization, quality, and risk adjustment outcomes. + Develop reports and dashboards to… more